Re: MS diagnostic tests

Posted By CCF Neuro[P] MD,RPS on March 18, 1999 at 20:25:55:

In Reply to: Re: MS diagnostic tests posted by Marie on March 17, 1999 at 13:32:28:






: : Dear MD,
: : I was diagnosed with MS 3years ago.I have a history of parasthesia in my right arm and right chest three years ago. Weakness and numbness in my rt leg 6 years ago. Lehrmittes 4 years ago. And just recently a little of both. All these episodes lasted a few weeks and I have no residual disability. My MRI from 3 years ago showed small areas of increased signal at C5 and C6. Brain was neg..  My recent MRI showed one area with a decrease in size and a new larger area at c6-7. Brain is still neg. Evolked response negative.  Optic nerves normal. I have not had a lumbar puncture. I went to a new neuro to talk about starting ABC drugs. He ordered the following labs,RPR, Rheumatoid Factor, RPR, IGM, B-12, and Lymes ELISA. B-12 was high. The rest were normal. ANA is not back yet.
: : My concern is I have been having hip joint pain, worse at night and after rest for about a month now.  I have a history of the same type of pain in my elbows a year ago. I have no stamina.  My breasts also are extremely tender prior to my menses and produce milk, only a drop at a time. I am not sure if this is normal or not?  My neck creeks and snaps.  I also have a history of migraines. My FP doc has basically dismissed Lymes because of the negative ELISA. I am concerned about the arthritic symptoms.  I camp a lot!!  Have never had a rash that I know of. My neuro wants to do a Lumbar puncture. Is this a good next step and what tests should be done. Neither of my docs seem to take the possibility of Lymes seriously. I have never even been questioned for possible symptoms.  I am in an HMO and am kind of  stuck.  So I am trying to look out for myself.  
: : Thanks for any help,
: : Marie    




Dear Marie:
Sorry to hear about all the problems.  What you describe is MS, and I would think that your neurologist was probably verifying the diagnosis.  Isolated spinal cord MS is not the usual but it is well documented.  I am not sure what to contribute the hip pain and breast tenderness with milk production.  The latter might be prolactin secretion and I would advise you to seek out an endocrinologist and have the pituitary function looked at.  Breast tenderness is noted in MS and we have seen this in many of our MS females but usually they do not produce milk.  The elbow pain was likely due to your MS lesion at C5-C6, which might also have a function in your breast tenderness.  Did they find anything at the upper lumbar spine in your last MRI?  
The question of a LP.  I would think that the idea of lyme disease, unless you live in an area of infestation or history of tick bite is rather remote.  The LP might help you in seeing if there is active disease occuring as your oligoclonal bands might be increased.  I'm not sure if it would otherwise add anything, except confirm your MS diagnosis.  I would also actively seek interferon treatment or copaxone treatment for your MS.  Best of luck.
Sincerely,
CCF Neuro[P] MD
_Thanks for the advice. In response to your question nothing was found in the upper lumbar spine.  The elbow pain was an arthritic type pain which worsened at rest and got better with movement .  I have camped in WI, IL, MO, KY, and CO prior to my symptoms. What is the criteria for suspecting Lymes and in what way do my symptoms not fit.  I am not trying to be disrespectful but want to be sure I am not overlooking anything that could be treatable!


___


: Thanks Marie




Dear Marie:
If your lyme titer was negative then it is very, very unlikely that you have lyme disease.  Lyme almost always has a characteristic rash that looks like a target-like lesion.  The area of the rash occurs where the tick bite occurred.  One can have an arthritis-like joint pain, any joint, with lyme but this occurs after the rash, by many months.  Again, without the rash and antibody titers, then lyme is not very likely.  
Sorry, you said you had joint pain, since the lesion on MRI was C5/C6 which includes the muscles that flex the elbow, I thought it might be the result of the MRI lesion.  If you think that it is arthritis then fine.
Sincerely,
CCF Neuro MD